http://doi.org/10.33698/NRF0078 – Suresh K.Sharma, Jogindra Vati, Indarjit Wali, Ramesh Sen
Abstract : Nicotine has a vasoconstrictive effect that inhibits tissue differentiation and the angiogenic response necessary in the early stages of fracture healing. Furthermore, vasoconstrictive effect of nicotine interferes with blood supply to tissues thus make it vulnerable for infection2. This descriptive study was conducted during months of Jan-Feb 2005 in selected wards of Nehru hospital PGIMER, Chandigarh. Total 50 patients with 54 external skeletal fixators and 321 pin sites were studied.
Findings of the study revealed that smokers had higher pin site infection rate i.e. 80% (16/20) in comparison to nonsmokers (53.3%). It was found statistically significant (p < 0.05). Therefore, it is recommended that every orthopedic nurse need to implement smoking cessation and meticulous pin site care practices for patients with external skeletal fixation
.Key words :
Smoking, pin-site infection, external skeletal fixation
Correspondence at :
Suresh K. Sharma,
Lecturer,
College of Nursing, DMCH, Ludhiana .
Introduction
There has been increasing interest in the sequela of smoking on the musculoskeletal system and wound healing1. Both eqidemilogic and experimental studies in the plastic surgery literature identify nicotine as the most deleterious constituent, leading to increased rates of wound complications and pedicle flap necrosis secondary to vasoconstriction and microthrombi formation1.
There is a growing body of literature on the impact of cigarette smoking on the muscluloskeletal system. Nicotine has a vasoconstrictive effect that inhibits tissue differentiation and the angiogenic response necessary in the early stages of fracture healing. Furthermore, nicotine interferes with osteoblast function and alters skeletal metabolism. Clinical observations parallel these findings. Cigarette smoking leads to an increased incidence of increased time to union in tibial fractures, lower bone mineral density, chronic osteomyelitis and clinical poor outcome2.
The external skeletal fixation method is well-established for the treatment of complicated musculoskeletal disorder, including open fracture, nonunion, osteomyelitis, angular deformities, and limb-length discrepancies1. Most patients treated with this method require both bone and soft-tissue healing for success. Experimental evidence suggests that cigarette smoking leads to decreased mineralization and mechanical strength of regenerate bone during tibial lengthening3,4. The purpose of this study was to examine the effect of cigarette smoking on pin site infection rate following external skeletal fixation.
Objective
To recognize the relationship between smoking and pin-site infection rate
Materials and Methods
This descriptive study was conducted in selected wards of Nehru Hospital, PGIMER, and Chandigarh during months of Jan-Feb 2005. It is tertiary care providing hospital which is well known for its trauma and emergency care facilities where annually about more than 400 patients are treated with external fixation. In months of Jan-Feb 2005, total 62 patients treated with external skeletal fixation. Out of them 50 consecutively purposively selected patients with 54 fixators and 321 pin sites were studied. All age group patients were included but patients with history of preoperative infection, immune suppression and local cutaneous infection were excluded from sample population. An identification data sheet and observation proforma was prepared to collect data. Validity was established by seeking the opinion of 5 experts who were from fields of research, nursing, orthopaedics and microbiology. A inter-rater reliability was also calculated and found to be significant for research tools. Selected patients’ pin sites were observed on 3rd, 5th and 7th postoperative day to determine the presence of pin site infection. The data were analyzed and presented by using descriptive and inferential statistics.
Results
Findings revealed that 92% males and 8% females with mean age of 31.38 13.41 years (6-70 years) belonged to rural (68%), urban (30%) and slum (2%) areas. In fifty patients and 54 fixators, total 321 pin sites’ infection occurrence was observed for a week postoperatively.
Table 1 & figure 1 depict relationship of pin site infection and smoking habit among subjects. It has been revealed that smokers had higher pin site infection rate i.e. 80% (16/ 20) in comparison to nonsmokers i.e. 53.3% (16/30) Chi-square test was applied to see the statistical significance of this difference in pin site infection rate. Results had shown that
calculated value of 2 (3.86) was more than the tabulated value (3.84) at 5% level of significance and one degree of freedom. This difference in pin site infection rate between smokers and nonsmokers was found statistically significant (p < 0.05).
Table – 1: Smoking habit and pin site infection among subjects N = 50
| Smoking habits
Pin site Infection |
Smokers f ( % ) | Nonsmokers f ( % ) | Total f | Chi-square value |
| Present | 16 (80.00) | 16 (53.33) | 32 |
x2cal. = 3.86* |
| Absent | 04 (20.00) | 14 (46.67) | 18 | |
| Total | 20 | 30 | 50 |
*Significant (p < 0.05), d.f.= 1
Discussion
Pin site infection is the most common complication of external skeletal fixation. In present study finding revealed that 92% males and 8% females with mean age of 31.38 ±13.41 years (6-70 years) belonged to rural (68%), urban (30%) and slum (2%) areas. In fifty patients and 54 fixators, total 321 pin sites occurrence of infection was observed for a week postoperatively.
It was revealed that smokers reported to have higher pin site infection rate (80%) than nonsmokers (53.3%), which was found statistically significant (p<0.05). Similar findings had been reported by Mckee et al4 where they found that incidence of the pin site infection was significantly higher among smokers (p=0.049). Ward5 also described the correlation between smoking and pin site infection, where he reported that smokers are likely to have more chances of pin site infection and delayed wound healing.
Conclusion
Nicotine consumption causes vulnerability of higher rates of pin site infection among patients with external skeletal fixation. Therefore, it is recommended that smoking cessation and meticulous pin site care practices need to be implemented for patients with external skeletal fixation.
References
- Adams CI, Keaating JF, Court-Brown Cigarette smoking and open tibia fractures. Injury 2001;32:61-65.
- Por ter SE, Hanely The musculoskeletal effects of smoking. J Am Acad Orthop Surg 2001;9:9-17.
- Schmitz M, Finnegan M, Champine The effect of smoking on the clinical healing of tibia shaft fracture healing. Clin Orthop 1999;365; 184-200.
- Mckee DM, Dipasauale JD, Wild ML, Stephen GJD, Kreder Schemitsch HE. The effect of smoking on clinical outcome and complication rates following Ilizarov reconstruction. Journal Of Orthopaedic Trauma 2003;17(10):663-667.
- Ward A one hospital study to determine the reaction prevalence and the infection risk indicators for skeletal pin sites. Journal of Orthopaedic Nursing 1997;1:173-178.